Table Of ContentCANA01ANA
u '^l"- 21 1998
CONTINUOUS
IMPROVEMENT
PROCESS
^ Health and Health System
Expectations and Measures:
A Consultation Paper
March 1998
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For additional copies of this report, contact:
Standards and Measures Branch
Alberta Health
22°^^ Floor, 10025 Jasper Avenue
Edmonton AB T5J2N3
Phone: (403) 427-0407
ISBN 0-7785-0055-1
Table of Contents
EXECUTIVE SUMMARY 1
INTRODUCTION 2
PURPOSE OF THIS CONSULTATION PAPER 3
WHERE WE ARE GOING 4
CLARIFYING TERMS 5
RELATIONSHIP OF EXPECTATIONS AND MEASURES
TO ACCOUNTABILITY AND BUSINESS PLANS 6
ROLES AND RESPONSIBILITIES 7
ALBERTA'S EXPECTATIONS AND MEASURES
FRAMEWORK 8
Health Services Expectations 9
Governance and Management Expectations 10
Use of the Framework 11
SETTING PRIORITIES 12
NEXT STEPS 14
CONSULTATION QUESTIONS 15
APPENDICES 16
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in 2015
https://archive.org/details/healthhealthsystOOalbe
EXECUTIVE SUMMARY
The Expectations and Measures project is one of the essential next steps in furthering accountabiUty
and continuous improvement in Alberta's health system. This paper is intended for use in discussions
with health authorities and other key stakeholders, for the purpose of obtaining feedback on:
• a proposed framework, including six quahty dimensions;
• criteria for setting priorities for the development of expectations and measures;
• roles and responsibilities of the various parties involved;
• processes to be followed in taking the next steps.
The paper proposes a framework for setting health and health system expectations (which include
goals, guidelines, standards, targets and benchmarks), identifying appropriate measures, and
monitoring performance against expectations. This involves two streams of expectations for health
authorities:
• general expectations related to governance and management of the health system, including
expectations about population health and health determinants;
• specific expectations related to the delivery of health services.
A draft template has been produced to serve as a tool for defining and organizing expectations and for
developing the related measures and monitoring systems. This template will also accommodate
existing expectations and measures. Six quahty dimensions are proposed related to the delivery of
health services:
0 appropriateness
0 effectiveness
0 safety
0 efficiency
0 accessibihty
0 acceptability
Once agreement has been reached on the framework, priorities need to be set to guide discussions
about where new expectations and measures are most needed. Suggested criteria for use in setting
priorities are:
0 relationship to health needs
0 potential for improved results
0 relationship to health system directions
0 safety risk
0 vulnerable population groups
0 volume
0 cost
0 importance to public
Consultations with stakeholders will provide the feedback necessary for this project to move forward
in estabUshing a s olid base of expectations and measures for health and the health system in Alberta.
1
Health and Health
INTRODUCTION
System Expectations
and Measures:
A Consultation Paper Albertans place a high value on their health and their health system.
They want effective ways of protecting health and preventing illness to
be in place. They also want Alberta's health system to provide high
quality services when they need them.
People in the health system are working hard to achieve those results.
Over the past few years, there has been considerable change in the way
Alberta's health system operates. Health authorities coordinate the
delivery of a w ide range of health services within a defined geographic
area. There's more emphasis on having the various parts of the health
system work together to meet the needs of individual Albertans. We're
expanding the focus of health to include not only treating people when
they are sick but also considering a broad range of factors that influence
people's health on an ongoing basis. And we're putting greater
emphasis on defining expectations, measuring results, and using that
information to improve health outcomes and management of the health
system. "Expectations" is a broad concept, defined as a desired result,
which may be expressed as a goal, standard (minimum requirement),
target, benchmark or guideline.
This consultation paper on expectations and measures is a key part of the
"next steps" in achieving accountability and continuous improvement in
Alberta's health system. By defining clear expectations, monitoring
performance on a set of agreed upon measures, and taking appropriate
follow up action, we can ensure that we continue to improve health
system performance. And we can assure Albertans that their health
system is well managed, providing the quality of care they expect, and
most important, improving the health of Albertans.
To ensure continuous improvement in Alberta's health system, several
steps in a continuous loop must be followed (Figure 1). The process
flows from establishing goals/expectations and related measures,
through to selecting and implementing strategies, monitoring/reporting,
evaluation and decision-making.
2
Health and Health Establish Goals
& Performance
System Expectations Measures
and Measures:
A Consultation Paper
MaiCnhtaanign e or Select
Strategies
Course
Take Action
Evaluate
& Monitor
Results
Progress
Report on
Results
Figure 1
PURPOSE OF THIS CONSULTATION PAPER
The purpose of this consultation paper is to propose and get feedback
on: a framework for defining health and health system expectations
and measures, criteria for determining priorities for the development of
expectations and measures, roles and responsibilities of the various
parties involved, and processes to be followed in taking the next steps.
Determining priorities and developing expectations and measures will
require joint work between Alberta Health and other partners in
Alberta's health system.
Although a range of stakeholders need to be involved in various aspects
of defining expectations and measuring performance, this consultation
paper is a first step and is focused primarily on health authorities. It
does not address the role of professional associations in developing and
implementing professional standards to ensure their members are
capable of providing the services in their scope of practice. This topic
is addressed separately through existing health profession legislation
and is currently being revisited in consultations underway regarding the
draft Health Professions Act. However, expectations established for
health authorities provide the context for the professions' standards of
practice and clinical practice guidelines, and all health care
practitioners play an integral role in the development, implementation
and monitoring of expectations and measures.
3
Health and Health WHERE WE ARE GOING
System Expectations
and Measures:
A Consultation Paper Initially we will focus primarily on health determinants influenced by
the health system, but as the jframework is expanded and revised over
time, we will begin to examine expectations and measures of health
determinants influenced by other government departments and agencies
and other levels of government. Factors such as living and working
conditions, education, and personal health practices generally have a
greater role to play thaa does the health system in determining how
healthy we can be. A focus on the health of the population forces us to
look beyond the use of health services and the health status of
individuals to a wider range of factors when we are setting expectations
for, aad measuring, health.
Alberta Health's long term goal is to have a full set of expectations
about, and measures of, health, the key factors influencing population
and individual health, as well as the key aspects of high quality and cost
effective health services delivery. When fully developed, this set of
expectations and measures will cut across departmental and
jurisdictional boundaries. The approach will not be limited only to
health determinants for which the health care system has direct
responsibility.
This comprehensive framework of expectations and measures for all
aspects of health will be developed collaboratively with those who
share responsibility for the other determinants of health. In the
meantime, we will continue to work jointly with other departments
regarding the performance measures and targets that have aheady been
identified in government business plans. The expectations and
measures in our framework will be updated regularly based on
information gathered through monitoring health status, performance,
international trends and research evidence.
We will also require effective mechanisms to monitor and evaluate
performance against expectations. This information will need to be fed
back in a timely manner to those responsible for achieving the expected
results. The information will be used at all levels of the health system
as well as outside the health system to improve strategies and
outcomes, stop ineffective and inefficient activities, and to revise
expectations and priorities. Monitoring information will also be used to
identify areas requiring further analysis or research.
A key support vehicle for this work will be an effective information
system which provides a b ase of common, timely and accessible
information across Alberta's health system. Work on developing such a
system is underway through the alberta we//net program. This program
4
Health and Health involves stakeholders across the health system. The Strategic Blueprint
System Expectations
developed for alberta we//net lays out a roadmap for establishing a
and Measures:
A Consultation Paper province-wide health information system. The vision of we//net is
"better information for better health". Developments in alberta we//net
will be linked directly to fiiture work on expectations and measures so
we can ensure that the information needed to assess results is collected,
standardized and accessible across the system. This also requires that
clear rules be in place to ensure that the privacy of individual
Albertans' health information is protected.
CLARIFYING TERMS
There are a n umber of key terms used in this document which require
definition to ensure that we're consistent in how the terms are used (see
Appendix A for a complete set of definitions).
Expectation is a broad concept defined as a desired result, as set out in
a goal, standard, target, benchmark or guideline.
A measure is a quantitative tool used to assess progress in meeting
expectations.
A goal is a broad statement of a desired condition which is potentially
attainable, though not necessarily easily or within a short time fi-ame.
Standards, targets, benchmarks and guidelines are more specific
statements of expectation, and would often relate to or derive from a
goal.
• Standard has many different definitions but the definition adopted
by Alberta Health is "a minimum requirement to be met, as set out
by a competent authority or based on available evidence". Some
standards may be codified in legislation.
• A target is a specific expectation stating the desired level of, or
change in, performance to be achieved, usually within a given time
period. Targets may be based on standards, but may also be based
on goals or benchmarks.
• A benchmark is a "best in class" comparator. It is a high level of
performance that others achieve when undertaking similar tasks and
responsibilities within a comparable context.
5
